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A 44-year-old man with a 9-day-old left displaced midshaft clavicle fracture was initially treated conservatively. The patient experienced an increase of pain with tickling and cold sensation in the left upper extremity. CT angiography showed left subclavian artery occlusion over 3 cm at the level of the fracture. At surgical repair, a subclavian-brachial bypass was constructed and fracture fixation was done with an eight-hole locking compression plate. Follow-up at 6 months showed full range of motion of the left shoulder, an open bypass and fracture consolidation.